Background:There is controversy over the optimal early protein delivery in critically ill patients with acute kidney injury(AKI).This study aims to evaluate whether the association between early protein delivery and 2...Background:There is controversy over the optimal early protein delivery in critically ill patients with acute kidney injury(AKI).This study aims to evaluate whether the association between early protein delivery and 28-day mortality was impacted by the presence of AKI in critically ill patients.Methods:This is a post hoc analysis of data from a multicenter cluster-randomised controlled trial enrolling newly admitted critically ill patients(n=2772).Participants without chronic kidney disease and with complete data concerning baseline renal function were included in this study.The primary outcome was 28-day mortality.Cox proportional hazards models were used to analyze the association between early protein delivery,reflected by mean protein delivery from day 3-5 after enrollment,28-day mortality and whether baseline AKI stages interacted with this association.Results:Overall,2552 patients were included,among whom 567(22.2%)had AKI at enrollment(111 stageⅠ,87 stageⅡ,369 stageⅢ).Mean early protein delivery was 0.60±0.38 g/kg/day among the study patients.In the overall study cohort,each 0.1 g/kg/day increase in protein delivery was associated with a 5%reduction in 28-day mortality[hazard ratio(HR)=0.95;95%confidence interval(CI)0.92-0.98,p<0.001].The association between early protein delivery and 28-day mortality significantly interacted with baseline AKI stages(adjusted interaction p=0.028).Each 0.1 g/kg/day increase in early protein delivery was associated with a 4%reduction in 28-day mortality(HR=0.96;95%CI 0.92-0.99,p=0.011)among patients without AKI and 9%(HR=0.91;95%CI 0.84-0.99,p=0.021)among those with AKI stageⅢ.However,such associations cannot be observed among patients with AKI stagesⅠandⅡ.Conclusions:Increased early protein delivery(up to close to the guideline recommendation)was associated with reduced 28-day mortality in critically ill patients without AKI and with AKI stageⅢ,but not in those with AKI stageⅠorⅡ.展开更多
文摘Background:There is controversy over the optimal early protein delivery in critically ill patients with acute kidney injury(AKI).This study aims to evaluate whether the association between early protein delivery and 28-day mortality was impacted by the presence of AKI in critically ill patients.Methods:This is a post hoc analysis of data from a multicenter cluster-randomised controlled trial enrolling newly admitted critically ill patients(n=2772).Participants without chronic kidney disease and with complete data concerning baseline renal function were included in this study.The primary outcome was 28-day mortality.Cox proportional hazards models were used to analyze the association between early protein delivery,reflected by mean protein delivery from day 3-5 after enrollment,28-day mortality and whether baseline AKI stages interacted with this association.Results:Overall,2552 patients were included,among whom 567(22.2%)had AKI at enrollment(111 stageⅠ,87 stageⅡ,369 stageⅢ).Mean early protein delivery was 0.60±0.38 g/kg/day among the study patients.In the overall study cohort,each 0.1 g/kg/day increase in protein delivery was associated with a 5%reduction in 28-day mortality[hazard ratio(HR)=0.95;95%confidence interval(CI)0.92-0.98,p<0.001].The association between early protein delivery and 28-day mortality significantly interacted with baseline AKI stages(adjusted interaction p=0.028).Each 0.1 g/kg/day increase in early protein delivery was associated with a 4%reduction in 28-day mortality(HR=0.96;95%CI 0.92-0.99,p=0.011)among patients without AKI and 9%(HR=0.91;95%CI 0.84-0.99,p=0.021)among those with AKI stageⅢ.However,such associations cannot be observed among patients with AKI stagesⅠandⅡ.Conclusions:Increased early protein delivery(up to close to the guideline recommendation)was associated with reduced 28-day mortality in critically ill patients without AKI and with AKI stageⅢ,but not in those with AKI stageⅠorⅡ.
